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CITY OF SAN MARCOS <br />DISCLOSURE AFFIDAVIT-BUSINESS ENTITY <br />STATE OF TEXAS <br />COUNTY OF HAYS <br />The undersigned member of the City of San Marcos 0.123 6?5-t , (name of City Board, <br />Commission, etc.) states under oath as follows: <br />I have a substantial interest in a business entity that may be involved ina vote or decision'of the governmental body <br />described above, and the vote or decision may have a special economic effect on the business entity that is <br />distinguishable from the effect on the public. The name of the business entity is 1-2 )c as S-.?--? <br />The nature and extent of my interest in the business entity is as follows: (check oil that apply) <br />Ownership of 10 percent or more of the voting stock or shares of the business entity. <br />Ownership of 10 percent or more of the fair market value of the business entity. <br />Ownership of $15,000 or more of the fair market value' of the business entity. <br />Funds received by me from the business entity exceed 10 percent of my gross income for the previous year. <br />The interest described above belongs to a person related to me in the first degree by consanguinity. (natural <br />kinship) or affinity (marriage). Relative's name and relation: <br />The vote or decision involving this interest is on the DL?V- (date) agenda of the.governmental <br />" <br />body, and is described as follows: sit JZ A ewe 4!g v <br />EXECUTED on (date). <br />Signature 1 - - <br />Printed Name GI ?O`? K' ~ ?? i VA <br />i <br />re me on (date). <br />S ,,, , <br />OMACK <br />°? Notary Public, State of Texas <br />s ti My Commission Expires <br />No r'?,`;,,,,,,• p' August 13, 2005 Notla?y Public <br />State of Texas <br />FILED on j1 du ' 96 ?4,0 ? (date). <br />City rk of the City of San Marcos <br />COSM Form 4/02